Variety and quantity of dietary protein intake from different sources and risk of new-onset diabetes: a Nationwide Cohort Study in China

Background The relation of the variety and quantity of different sources of dietary proteins intake and diabetes remains uncertain. We aimed to investigate the associations between the variety and quantity of proteins intake from eight major food sources and new-onset diabetes, using data from the China Health and Nutrition Survey (CHNS). Methods 16,260 participants without diabetes at baseline from CHNS were included. Dietary intake was measured by three consecutive 24-h dietary recalls combined with a household food inventory. The variety score of protein sources was defined as the number of protein sources consumed at the appropriate level, accounting for both types and quantity of proteins. New-onset diabetes was defined as self-reported physician-diagnosed diabetes or fasting glucose ≥7.0mmol/L or glycated hemoglobin ≥6.5% during the follow-up. Results During a median follow-up of 9.0 years, 1100 (6.8%) subjects developed diabetes. Overall, there were U-shaped associations of percentages energy from total protein, whole grain-derived and poultry-derived proteins with new-onset diabetes; J-shaped associations of unprocessed or processed red meat-derived proteins with new-onset diabetes; a reverse J-shaped association of the fish-derived protein with new-onset diabetes; L-shaped associations of egg-derived and legume-derived proteins with new-onset diabetes; and a reverse L-shaped association of the refined grain-derived protein with new-onset diabetes (all P values for nonlinearity<0.001). Moreover, a significantly lower risk of new-onset diabetes was found in those with a higher variety score of protein sources (per score increment; HR, 0.69; 95%CI, 0.65–0.72). Conclusions There was an inverse association between the variety of proteins with appropriate quantity from different food sources and new-onset diabetes.

U-shaped Association Between Dietary Zinc Intake and New-onset Diabetes: A Nationwide Cohort Study in China

Aims We aimed to investigate the relationship of dietary zinc intake with new-onset diabetes among Chinese adults. Materials and Methods A total of 16 257 participants who were free of diabetes at baseline from the China Health and Nutrition Survey were included. Dietary intake was measured by 3 consecutive 24-hour dietary recalls combined with a household food inventory. Participants with self-reported physician-diagnosed diabetes, or fasting glucose ≥ 7.0 mmol/L, or glycated hemoglobin ≥ 6.5% during the follow-up were defined as having new-onset diabetes. Results A total of 1097 participants developed new-onset diabetes during a median follow-up duration of 9.0 years. Overall, the association between dietary zinc intake and new-onset diabetes followed a U-shape (P for nonlinearity &lt; 0.001). The risk of new-onset diabetes was significantly lower in participants with zinc intake &lt; 9.1 mg/day (per mg/day: hazard ratio [HR], 0.73; 95% CI, 0.60-0.88), and higher in those with zinc intake ≥ 9.1 mg/day (per mg/day: HR, 1.10; 95% CI, 1.07-1.13). Consistently, when dietary zinc intake was assessed as deciles, compared with those in deciles 2-8 (8.9 -&lt;12.2 mg/day), the risk of new-onset diabetes was higher for decile 1 (&lt;8.9 mg/day: HR, 1.29; 95% CI, 1.04-1.62), and deciles 9 to 10 (≥12.2 mg/day: HR, 1.62; 95% CI, 1.38-1.90). Similar U-shaped relations were found for plant-derived or animal-derived zinc intake with new-onset diabetes (all P for nonlinearity &lt; 0.001). Conclusions There was a U-shaped association between dietary zinc intake and new-onset diabetes in general Chinese adults, with an inflection point at about 9.1 mg/day.

Inverse Association Between Riboflavin Intake and New-Onset Hypertension

The prospective relation of dietary riboflavin intake with hypertension remains uncertain. We aimed to investigate the relationship of dietary riboflavin intake with new-onset hypertension and examine possible effect modifiers in general population. A total of 12 245 participants who were free of hypertension at baseline from China Health and Nutrition Survey were included. Dietary intake was measured by 3 consecutive 24-hour dietary recalls combined with a household food inventory. The study outcome was new-onset hypertension, defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg or diagnosed by physician or under antihypertensive treatment during the follow-up. A total of 4303 (35.1%) subjects developed hypertension during 95 573 person-years of follow-up. Overall, there was a nonlinear, inverse association between total, plant-based, or animal-based riboflavin intake and new-onset hypertension (all P for nonlinearity, <0.001). The risk of new-onset hypertension was increased only in participants with relatively lower riboflavin intake. Accordingly, a significantly lower risk of new-onset hypertension was found in participants in quartiles 2 to 4 of total riboflavin intake (hazard ratio, 0.74 [95% CI, 0.68–0.80]), plant-derived riboflavin intake (hazard ratio, 0.77 [95% CI, 0.71–0.84]), or animal-derived riboflavin intake (hazard ratio, 0.70 [95% CI, 0.65–0.77]), compared with those in quartile 1. In addition, the association between total riboflavin intake and new-onset hypertension was particularly evident in those with lower dietary sodium/potassium intake ratio ( P interaction, <0.001). In summary, there was an inverse association between riboflavin intake and new-onset hypertension in general Chinese adults. Our results emphasized the importance of maintaining relatively higher riboflavin intake levels for the prevention of hypertension.

Chili Intake Is Inversely Associated with Chronic Kidney Disease among Adults: A Population-Based Study

We aimed to assess the association between chili consumption and kidney function and chronic kidney disease (CKD). Data from 8429 adults attending the China Health and Nutrition Survey were used. Chili intake was assessed using a 3 day, 24 h food record in combination with household food inventory between 1991 and 2009. CKD was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2, as measured in 2009. Logistic regression was used to assess the association. Of the 8429 participants, 1008 (12.0%) fit the definition of CKD. The prevalence of CKD was 13.1% in non-consumers of chili and 7.4% among those with chili intake above 50 g/day. After adjusting for demographics, lifestyle factors (i.e., smoking, alcohol drinking, physical activity), dietary patterns, and chronic conditions, the odds ratio (OR) (95% CI) for CKD across chili consumption levels of none, 1–20 g/day, 20.1–50 g/day, ≥50.1 g/day were 1.00 (reference), 0.82 (0.67–1.01), 0.83 (0.65–1.05), and 0.51 (0.35–0.75), respectively (p for trend 0.001). There was no interaction between chili intake with gender, income, urbanization, hypertension, obesity, or diabetes. This longitudinal large population-based study suggests that chili consumption is inversely associated with CKD, independent of lifestyle, hypertension, obesity, and overall dietary patterns.

Legume consumption and risk of hypertension in a prospective cohort of Chinese men and women

Prior data on long-term association between legume consumption and hypertension risk are sparse. We aimed to evaluate whether total legume and subtype intakes prospectively associate with hypertension incidence among 8758 participants (≥30 years) from the China Health and Nutrition Survey 2004–2011. Diet was assessed by interviews combining 3-d 24-h food recalls and household food inventory weighing at each survey round. Incident hypertension was identified by self-reports or blood pressure measurements. We applied multivariable Cox regressions to estimate hazard ratios (HR) with corresponding 95 % CI for hypertension across increasing categories of cumulatively averaged legume intakes. For 35 990 person-years (median 6·0 years apiece), we documented 944 hypertension cases. After covariate adjustment, higher total legume intakes were significantly associated with lower hypertension risks, with HR comparing extreme categories being 0·56 (95 % CI 0·43, 0·71; Ptrend < 0·001). Then we found that intakes of dried legumes (HR 0·53 (95 % CI 0·43, 0·65); Ptrend < 0·001) and fresh legumes (HR 0·67 (95 % CI 0·55, 0·81); Ptrend < 0·001) were both related to decreased hypertension hazards. However, further dried legume classification revealed that negative association with hypertension substantially held for soyabean (HR 0·51 (95 % CI 0·41, 0·62); Ptrend < 0·001) but not non-soyabean intakes. In stratified analyses, the association of interest remained similar within strata by sex, BMI, physical activity, smoking and drinking status; rather, significant heterogeneity showed across age strata (Pinteraction = 0·02). Total legume consumption among the over-65s was related to a more markedly reduced hypertension risk (HR 0·47 (95 % CI 0·30, 0·73); Ptrend < 0·001). Our findings suggest an inverse association of all kinds of legume (except non-soyabean) intakes with hypertension risks.

Longitudinal analysis of dietary patterns in Chinese adults from 1991 to 2009

In the present study, we aimed to identify the changes or stability in the structure of dietary patterns and tracking, trends and factors related to the adherence to these dietary patterns in China from 1991 to 2009. We analysed dietary data collected during seven waves of the China Health and Nutrition Survey and included 9253 adults with complete dietary data for three or more waves. Dietary intake assessment was carried out over a 3 d period with 24 h recalls and a household food inventory. Using factor analysis in each wave, we found that the structure of the two dietary patterns identified remained stable over the studied period. The traditional southern dietary pattern was characterised by high intakes of rice, fresh leafy vegetables, low-fat red meat, pork, organ meats, poultry and fish/seafood and low intakes of wheat flour and maize/coarse grains and the modern high-wheat dietary pattern was characterised by high intakes of wheat buns/breads, cakes/cookies/pastries, deep-fried wheat, nuts/seeds, starchy root/tuber products, fruits, eggs/egg products, soya milk, animal-based milk and instant noodles/frozen dumplings. Temporal tracking (maintenance of a relative position over time) was higher for the traditional southern dietary pattern, whereas adherence to the modern high-wheat dietary pattern had an upward trend over time. Higher income, education and urbanicity levels were positively associated with both the dietary patterns, but the association became weaker in the later years. These results suggest that even in the context of rapid economic changes in China, the way people chose to combine their foods remained relatively stable. However, the increasing popularity of the modern high-wheat dietary pattern, a pattern associated with several energy-dense foods, is a cause of concern.